Provider Demographics
NPI:1871795047
Name:CAIN, MELISSA SUE (MD)
Entity type:Individual
Prefix:DR
First Name:MELISSA
Middle Name:SUE
Last Name:CAIN
Suffix:
Gender:F
Credentials:MD
Other - Prefix:DR
Other - First Name:MELISSA
Other - Middle Name:SUE
Other - Last Name:BUNTON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:245 W JOHNSON RD STE 7
Mailing Address - Street 2:
Mailing Address - City:LA PORTE
Mailing Address - State:IN
Mailing Address - Zip Code:46350-2026
Mailing Address - Country:US
Mailing Address - Phone:219-262-0037
Mailing Address - Fax:678-487-5329
Practice Address - Street 1:245 W JOHNSON RD STE 7
Practice Address - Street 2:
Practice Address - City:LA PORTE
Practice Address - State:IN
Practice Address - Zip Code:46350-2026
Practice Address - Country:US
Practice Address - Phone:219-262-0037
Practice Address - Fax:678-487-5329
Is Sole Proprietor?:Yes
Enumeration Date:2007-06-01
Last Update Date:2024-03-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN01064530A207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN200908150Medicaid
IN000000610100OtherBCBS MED PT IRELAND RD
IN000000611461OtherBCBS BMG LAPORTE
IN000001038705OtherANTHEM
INP00752259OtherRR MEDICARE
IN565800I6Medicare PIN
IN000000610100OtherBCBS MED PT IRELAND RD
IN23604012Medicare PIN